N.Y. negotiates national settlement with Cigna on opioid treatment

NEW YORK, NEW YORK - SEPTEMBER 23: New York Attorney General Eric Schneiderman speaks during a press conference regarding a record drug bust involving heroin and fentenyl in September.(Photo: Drew Angerer, Getty Images)

The insurer Cigna will no longer require pre-authorization for prescriptions to treat opioid addiction under the terms of a national settlement announced late Thursday by New York Attorney General Eric Schneiderman.

Doctors and patients complain that while it may be common to require doctors to get prior approval for other prescriptions, a delay in getting medication-assisted treatment (MAT) for heroin addiction can be deadly, as addicts can easily relapse and overdose. While pre-authorizations should just take hours, it can often take days if there are problems with the paperwork.

"Getting people into treatment faster, and when the window of opportunity is open, is vital to stemming the opioid addiction crisis,” Schneiderman said in a statement. “Other health insurers should take notice of Cigna’s actions to remove access barriers to treat opioid dependency and I encourage those insurers to follow suit.”

Schneiderman's office still has inquiries open into restrictions other insurers have on what's known as medication-assisted treatment (MAT), but would not disclose the name of the insurers. Under a law enacted this year, Medicaid plans in New York can no longer require pre-authorizations for buprenorphine, one of the most effective medication treatments for addiction, but commercial insurance is not covered by the law.

"We appreciate the ongoing leadership of the New York Office of the Attorney General on this matter," Cigna said in a statement.

The agreement was heralded as important for the safety of patients.

"It is very encouraging to hear that insurers and lawmakers are reforming insurance practices that may be harmful to patients with addiction,” said Lindsey Vuolo, associate director of health for the National Center on Addiction and Substance Abuse. “Prior authorization is a significant barrier for people with addiction, because it creates delays,”

Dr. Mina “Mike” Kalfas, who treats more than 200 people with heroin addiction in Northern Kentucky, is among certified addiction experts nationwide who have had prior-authorizations hold up treatment for opioid- and heroin-addicted patients.

“I think it’s a great gesture. It’s good to see them catch up,” Kalfas said. “It’s a shame to think it took the threat of action to do the right thing, but nonetheless, I commend them for doing the right thing.”

Krista Sizemore, who was on Vivitrol, stopped using the drug to help with her heroin cravings because she knew it's not safe for her baby. But prior authorizations caused delays in her treatment.(Photo: Carrie Cochran)

Kimberly Wright, a Northern Kentucky advocate for those with addiction disease, said the company should be emulated by all insurers, private and Medicaid, across the nation.

Her daughter, Krista Sizemore, 26, of Newport, Ky., was faced with prior-authorization hold-ups twice when she was prescribed medication to treat her heroin addiction in August and September.

Wright, who founded a private Facebook group, Kentucky Parents Against Heroin, said addiction disease is “an emergency,” and people should be treated without hesitation or delays.

MAT, when prescribed and monitored properly, has been found to be safe, reasonably priced and effective in helping patients recover from opioid use disorder.

Unlike methadone, which must be administered under strict rules in certain clinics, MAT drugs — which usually contain buprenorphine and naloxone — can be prescribed or dispensed in doctors’ offices for opioid dependency, as long as the doctor is authorized. Mental health therapy and management of medical issues is also recommended.

Cigna’s policy change, which is effective Oct. 15, covers all of Cigna's commercial insurance plans. It came "just months" after Schneiderman requested that the insurer provide information about its MAT policies "to address concerns about barriers to treatment for opioid use disorder," according to the attorney general's office.

in its statement Thursday night, Cigna said the policy change "will help make it easier for our customers to access coverage for the medications they need."

"The misuse of opioids has taken a terrible toll in America, which is why Cigna is committed to reducing opioid use among our customers by 25 percent in three years," the company said.

Douglas Nemecek, Cigna’s chief medical officer for behavioral health, told the USA TODAY Network this summer that while some of its prescription plans require prior authorization for Suboxone — a brand name for buprenorphine — none require it for Vivitrol.

“We want to be sure substance abuse disorder is treated like any other chronic condition,” said Nemecek, a psychiatrist. “We don’t expect them to come in for one visit and be cured.”